Transitioning High-Dose AML Chemo to Outpatient Setting Improves Quality of Life

Transitioning a long-standing intensive chemotherapy regimen for AML to the outpatient setting is safe and feasible.
Transitioning a long-standing intensive chemotherapy regimen for AML to the outpatient setting is safe and feasible.

ORLANDO, FL—Transitioning a long-standing intensive chemotherapy regimen for acute myeloid leukemia (AML) to the outpatient setting is safe, feasible, and improves the patient experience by reducing the need for a hospital stay, according to a presentation at the ONS 40th Annual Congress.

“Treatment of AML, the most common adult acute leukemia, typically consists of intensive induction followed by high dose consolidation chemotherapy,” noted Bernadette Cuello, MSN, NP-C, of Memorial Sloan Kettering Cancer Center in New York, New York.

At the cancer center, consolidation with high dose intravenous cytarabine (HiDAC) had always required a 5-to-6-day inpatient admission.

“In our overall effort to reduce lengths of stay, we questioned whether consolidation with HiDAC could safely be transitioned to the outpatient setting,” she stated. “A multidisciplinary task force developed guidelines for HiDAC administration, patient education, and nursing roles and responsibilities.”

In the first 12 months, 15 patients received outpatient HiDAC during 23 occasions. Two doses of HiDAC were administered, 12 hours apart, the first in the outpatient infusion unit and the second by the patient at home using a CADD Prizm pump. Patients prepared for the self-infusion by participating in a 30-minute instruction session with an office practice nurse and by watching a video that included techniques for disconnecting the pump.

“Nurses communicated daily with patients at home through video conference using a WebEx platform,” Cuello stated.

During the initial phase, compared to the 20 hours a patient would spend in the hospital for consolidation with HiDAC, average time spent in the outpatient clinic was 13 hours over 5 days.

“In the second phase, when administration of both doses of chemotherapy occurred at home via the pump, on site time was reduced to 3 hours over 5 days,” she noted.

Of those, one patient required admission during treatment and nine required admission during recovery, of which seven developed febrile neutropenia, one developed severe thrombocytopenia, and one developed a total body rash with severe nausea and vomiting.

On the FACT-G instrument, patients rated their quality of life improved with home administration; a separate usability survey indicated high patient satisfaction with the WebEx conferencing.

“Innovative technical support systems for assessment and reinforcement of instructions added to patient comfort and overall satisfaction,” Cuello noted. The reduction in length of stay also increased access to acute care beds in the cancer center.

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